Prevalence and causes of visual field loss in the elderly and associations with impairment in daily functioning: the Rotterdam Study.

Objectives: To determine the prevalence and causes of visual field loss (VFL) and the association between VFL and indicators of impairment in daily functioning.

Design: Population-based cohort study.

Setting: Suburb of Rotterdam, the Netherlands.

Participants: Community-dwelling elderly residents (n = 6250).

Main Outcome Measure: Visual field loss on suprathreshold static, Goldmann kinetic perimetry, or both.

Methods: Suprathreshold testing of the central visual field was performed on both eyes and repeated if results were abnormal or unreliable. Goldmann perimetry was performed to confirm defects. Causes were determined using ophthalmologic and neurologic examination data and medical records. Impairment was assessed using data from interviews and medical records on disability in daily life, falling, and fractures.

Results: The overall prevalence of VFL was 5.6% (3.0% in those aged 55-64 years to 17.0% in those > or =85 years); glaucoma was the leading cause in all age groups. Before age 75 years, other optic nerve diseases and stroke ranked second and third, respectively, as did age-related macular degeneration and retinal vascular occlusive disease, respectively, after this age. Also, after adjustment for visual acuity, VFL was associated with disability, diminished enjoyment of reading and watching television, and a higher risk of incident falling. Risk of incident hip fracture was not increased.

Conclusions: Visual field loss is present in 1 of every 20 community-dwelling elderly people and is associated with impaired daily functioning. Glaucoma is the leading cause in all age groups. Other high-ranking causes, some of which are partly preventable, vary by age.